Healthcare Provider Details

I. General information

NPI: 1912736174
Provider Name (Legal Business Name): ALBA PLLANA DERVISHAJ RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALBA PLLANA DERVISHAJ ALBA PLLANA

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 BAINBRIDGE AVE # 4404
BRONX NY
10467-2404
US

IV. Provider business mailing address

3400 BAINBRIDGE AVE # 4404
BRONX NY
10467-2404
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4800
  • Fax:
Mailing address:
  • Phone: 718-920-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number011746
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: